Diabetic Foot

Diabetes is a long-term condition caused by defi­ciency in quantity or function of insulin, the chemical controlling the level of sugar in the blood. People with diabetes par­ticularly when poorly man­aged are often faced with various health challenges, one of the serious chal­lenges is improper healing of wound especially on the foot, which may lead to for­mation of large ulcer on the foot which may gradually spread to other parts of the body with time.

Diabetic foot ulcer develops in diabetics when poorly heal­ing wound leads to skin tissue death and breakdown expos­ing the layers underneath.

Diabetic foot is a common complication of diabetes and is the commonest reason for leg amputation, apart from traumatic causes. Though any diabetic person can de­velop diabetic foot ulcers it’s more common in people with poorly controlled diabetes.

The burden of Diabetic foot ulcer in Nigeria is very high. The major gaps in­clude low level of foot care knowledge among diabetic patients, overdependence on self-medication and unorth­odox medicine following development of foot ulcer­ation, late hospital presen­tation, and high amputation and mortality rates.

Cause

Diabetic feet occur as a re­sult of various factors, such as reduced blood flow in the foot, changes in the bone and supporting structure, and nerve damage.

Wound occur at a higher frequency and intensity in people with diabetes due to poor blood flow and nerve damage, this is because hu­man senses depend on nerves to function, with nerve dam­age in the feet the sense of touch and pain is lost, be­cause pain is the body’s way of telling that something is wrong. People with diabetes may be unaware when some­thing is wrong their feet, for example they may feel no pain even when standing on sharps, as a result of this, wound forming especially on the sole of the feet or in between toes may not be noticed for a long time, this leads to ulcer formation and subsequent infection. Be­cause diabetes also affects the repair processes of the body, wound healing is impaired, and ulcers can spread freely from the feet to the leg and other parts of the body.

SYMPTOMS AND SIGNS

Signs and symptoms usually begin gradually as reduced or abnormal sen­sation in the feet and if care is not taken progressively worsens until all sensation can no longer be felt in the feet. Because of the peculiar­ity of this condition, many diabetics may have no symp­toms before developing the ulcer.

signs of diabetes-related nerve damage may include:

Darkened skin and loss of hair in the affected area.

Diminished ability to sense hot or cold.

Tingling, numbness, ab­normal pain or weakness in the leg and foot

Diagnosis And Investigation

The classic diabetic ulcer must be distinguished from various other problems that tend to occur in people with diabetes, such as diabetic dermopathy.

Detection of diabetic foot is based on physical inspec­tion, but for proper diagnose of diabetes-related foot con­ditions, a healthcare provid­er will:

Ask about the general symptoms of diabetes and how it’s being managed and examine the toes, feet and legs with various tools to check for numbness and signs of infection.

If a diabetes-related ul­cer or blister is present, the healthcare provider may:

Take a sample of the skin or discharge to test for infec­tion and order imaging tests such as X-ray or MRI, this is to know the extent of dam­age in structure beneath the skin and plan treatment.

Treatment

Management of diabetic foot should involve health­care specialist.

Treatment depends on the level of damage.

Treatment may include:

Cleaning the wound and removing dead or infected tissue

Applying special bandag­es and ointments to protect the wound and help it heal.

Taking of weight off the affected foot using high-knee offloading device or crutches or wheel chair

Prescribing medications that promote wound healing and eliminate infection.

Sometimes amputation is necessary to save life when medication fails to prevent infection from spreading to other parts of the body.

Prevention

Blood sugar control: Key to prevention of complica­tions of diabetes is to ensure that the blood sugar level is well managed via regular use of medication, avoid­ance of high excessive calo­ry intake and refined sugar and regular check-up.

Diabetic foot screening: should be done at every visit to healthcare provider, diabetic foot examination is used to find foot health prob­lems in people with diabetes before they cause serious in­fection.

Feet hygiene: Washing the feet every day in warm water and drying them thoroughly afterward, in­cluding between the toes. Then apply lotion to the tops and bottoms of the feet and talcum powder between the toes. Toenails should be trimmed and filed, and cal­luses smoothened.

Regular inspection: checking the feet and be­tween the toes every day for any changes and having the soles or using a mirror.

Maintaining blood flow to the feet. For example, keep your feet elevated when you sit, and wiggle your toes of­ten. Stay active, but choose activities that are gentler on the feet, such as walking or swimming.

Wearing socks and shoes (or slippers) all day. Socks and shoes should not be tight. Use of therapeutic shoes or shoe inserts to help prevent wounds or sore.

Smoking cessation, hy­pertension and dyslipidemia control, and antiplatelet drug use, as the means to reduce cardiovascular risk.

Prognosis

When caught early, foot ulcers are treatable, howev­er the presence of spreading infection is associated with poor outcome and untreated infections may require am­putations.

MKO Abimbola holds a doctor­al degree in physician associate studies from the United States of America. He is a Harvard Medi­cal School scholar, affiliated with Parkland Memorial Hospital, Dallas, Texas. He specializes in Internal medicine, Acute care, Emergency Medicine, Geriat­rics, Psychiatry, and Surgical services.